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Acute Respiratory Failure
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Cardiac & Respiratory Arrest
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Acute respiratory failure is not a disease but a symptom of an underlying pathology that is
causing problems with oxygen and carbon dioxide (CO2) exchange (gas exchange) in the
lungs.
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Acute respiratory failure can be classified as hypoxemic or hypercapnic.
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Hypoxemic respiratory failure is also referred to as oxygenation failure and is characterized
by a partial pressure of oxygen (PaO2) level less than 60 mm Hg.
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Hypercapnic respiratory failure is often called ventilatory failure and is characterized by a !"#$%&'!()*+,-.+).
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PaCO2 level above 45 mm Hg (caused by the insufficient removal of CO2) and a pH < 7.35.
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Respiratory failure is caused by extra-pulmonary or intra-pulmonary causes, or a
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combination of the two.
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Extrapulmonary causes include:
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( *+,,%"-./-01"12+3+"#-%4-51$+ Neuromuscular and musculoskeletal disorders, such as spinal cord injuries, amyotrophic lateral sclerosis (ALS) and
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Guillain-Barré S6(7*-.%+&,T&!"#$"%&,%E%*%"7% )
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Central nervous system (CNS) dysfunction (e.g., stroke, opioids, anesthetics) '(86#%.%
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Intrapulmonary causes include:
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<5@534;("*C>7.5.- Chronic obstructive pulmonary disease (COPD) exacerbation, asthma attack

Pulmonary embolism

Pulmonary edema
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Acute respiratory distress syndrome (ARDS)

Pneumothorax
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Clinical Manifestations
Restlessness, confusion
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Dyspnea, orthopnea, tachypnea

Tachycardia
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Decreased pulse oximetry reading

Arterial blood gases typically show a pH below 7.35, partial pressure of carbon dioxide (PaCO2) greater than 50 mm

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<5@534;("*C>7.5.- Hypoxemia that persists even when 100% oxygen is given (refractory
hypoxemia) is a cardinal feature of respiratory failure due to ARDS.

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Diagnostic Studies
<5@534;(A+(B/*?/.44 Physical examination

Arterial blood gases

Chest X-ray
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Nursing Management
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Acute respiratory failure can quickly lead to respiratory arrest. Therefore early
identification and intervening quickly is key!

Priority nursing actions for the client experiencing acute respiratory failure include:
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Administration of high-flow oxygen until PaO2 or oxygen saturation is within an acceptable range, typically greater

than 80 mm Hg and 90%

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Intubation and mechanical ventilation may be necessary

<5@534;("*C>7.5.- Administer medications as prescribed for venous thromboembolism (VTE) and stress ulcer prophylaxis

Administer anxiolytics with caution to avoid CNS depression and worsen hypoventilation

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<5@534;(A+(B/*?/.44 The client with acute respiratory failure will require close and frequent
monitoring. The nurse must recognize when a higher level of care is required
and assist with transferring the client to the appropriate setting, e.g., from home
to the closest ER or from a medical-surgical floor to the intensive care unit
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(ICU).

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